On 26 September 2022, a hybrid meeting has been jointly organised by the Italian Ministry of Health and AGENAS with the aim of representing how some of the themes implemented within JADECARE (namely, hospital/territory integration and risk stratification) find a natural development and continuity also in various national activities, projects and policies, and therefore guarantee their sustainability. The meeting (in presence) was hosted in premises of the Ministry of Health in Rome, Italy.
AGENAS, the co-host, has been nominated by the Ministry of Health as the Competent Authority representing Italy in the Joint Action JADECARE. AGENAS is Co-leader of JADECARE’s Work Package (WP) No. 4, focused on the activities of integration in national policies and sustainability, and is referent for multiple activities, also related to other work packages.
The hybrid meeting was attended by ten representatives on site and 45 remote participants.
The agenda was divided into two parts: on the one hand, a part dedicated to risk stratification;on the other hand, hospital/territory integration was discussed among participants.
Marche and Tuscany regions presented their experiences with reference to the ongoing implementation of the Catalan and Basque good practices respectively. They implement a risk stratification tool based on adjusted morbidity groups (GMA) and build a health/disease map/dashboard for citizens and available services. The use of the GMA was useful to identify the number of nurses and social workers needed in Primary Care and, consequently, to allocate budget in Primary Care centers. In such case, the population stratification process is meant to identify high complexity patients through the integration of primary and hospital care.
AGENAS presented the PON GOV chronicity project and the crucial role of “community of practice” in the reorganization of regional health services. Furthermore, Lazio Region’s experience highlighted that population analyses for the ‘differentiation’ of interventions support the provision of a “multidimensional” system characterized by high flexibility: the target population can be in fact defined according to programming priorities, both at regional and local level.
The Ministry of Health highlighted that, although it has not yet completed the stratification activity at the national level, it is working on a “Predictive Model” for classifying the population based on disease. The Ministry therefore highlighted that the main requirement for the creation of such a complex model is the possibility of full use of all health information flows from the National Health Information System with further information sources interconnectable at an individual level. The difficulties in aggregating information from different sources have so far made this process complex, leading to the need to adapt the current regulatory framework regarding data interconnectivity, in line with the national and international regulatory framework on personal data processing.
Then it was the time of Umbria Region’s experience. With particular attention to the thematic of hospital/territory integration, Umbria concentrated its attention on care coordination and communication between health providers by creating a multidisciplinary team through the telemedicine platform between General Practitioners, Territorial and Hospital Specialists for the management of chronic patients and level II CUP (Single Reservation Centre) booking agendas. Umbria has confirmed that the push to carry out the interventions that have recently been applied in the regional integrated care system, thanks to which they have been able to digitalize all hospital processes, came from the JADECARE project, and the sustainability of these interventions is partly due to their technological nature, but also to the possibility of financing them in the future trough the PNRR funds.
An important role was played by the presentation of the national activities related to the PNRR, the National Recovery and Resilience Plan, which is part of Next Generation EU, the economic recovery project addressing EU member states. The PNRR includes a section, titled Mission 6, which contains all the interventions owned by the Ministry of Health, divided into two components (C): M6–1 – Proximity networks, structures and telemedicine for territorial health care / M6–2 – Innovation, research and digitization of the Health Service.
It is up to AGENAS, as an intermediary for the Ministry of Health, to implement the interventions relating to M6C1. AGENAS presented its dual function both as the “Implementing Administration” of the interventions titled “COT – Pilot Artificial Intelligence Project”; Portal of Transparency “; “Telemedicine – Home as the first place of care”), and also as the provider of operational technical support to the interventions for the creation of the “Community Homes and taking charge of the person”, “Home as the first place of care”, “Strengthening intermediate health care and its structures (Community Hospitals)” .
The MoH explained, first of all, the current system through which the state implements the integration between the hospitals and the territory, and how the PNRR has contributed and increased this system and what was the regulatory path put in place for carry out Mission 6.
With the presentation of the Piedmont Region, the information provided by AGENAS and the MoH was systematised, as the region explained how it put the MoH regulations into practice in the territory and how it received support from AGENAS in the context of the PNRR and PON GOV project.
In conclusion, the meeting was an important moment of sharing between the institutions and the territory, in which the role that each stakeholder has in relation to the issues dealt with, and how the activities of each party are interconnected with those of the others, were made more visible. All the partners participating in JADECARE agreed on how the involvement in the project has pushed them to implement substantial changes in their territory, which probably would have taken many years to occur without the project. They also noted how the actions implemented are sustainable over time, because they are very often connected to technological changes which, by their nature, have a long permanence over time. In particular, the ARS Toscana partners informed AGENAS that, during a regional meeting, the extensions introduced – thanks to the JADECARE project – to the local health system of the territories covered by the southeast ASL (Local Health Unit) and the central ASL, are being included in a regional act.
The discourse with the representatives of the Ministry of Health was very useful because, on the one hand, it clearly highlighted the national limits of the implementation of policies linked to the theme of territorial stratification and hospital / territory integration, and on the other hand, it revealed that successful initiatives have been implemented at the local level that have effectively improved the health system locally, and that can be considered for further expansion at a national scale.
A final discussion among all speakers highlighted the still-present critical points: Privacy regulation problems; organisational aspects due to Covid-19; Incommunicability of ICT tools,
The Ministry of Health confirmed its intention to conclude, as soon as possible, the administrative procedures related to the definition of the decree for overcoming the problems related to privacy.